In recent years, the number of people with type 2 diabetes has been steadily increasing, and it has become a major public health concern.
The disease is characterized by high levels of glucose in the blood due to the body’s inability to properly use insulin, a hormone that regulates blood sugar levels.
While the first line of treatment for type 2 diabetes is typically the drug metformin, some patients may require additional medications if their blood sugar levels are not adequately controlled.
Two of the most commonly prescribed second-line medications are sulfonylureas and basal insulin.
However, a recent study by scientists at Northwestern University has found that these two drugs carry a high risk of cardiovascular harm, including heart attacks, strokes, heart failure, and amputations.
The study is the first to compare how each of the six major second-line drugs impacts heart outcomes in Type 2 diabetes patients taking a second diabetes medication.
The team found that patients who take sulfonylureas or basal insulin are more likely to experience cardiovascular harm than those taking a newer class of diabetes drugs known as DPP-4 inhibitors.
The risk was 36 percent higher for sulfonylureas and twice as high for basal insulin.
According to the researchers, physicians should consider prescribing newer classes of antidiabetic medications, such as GLP-1 agonists, SGLT-2 inhibitors, or DPP-4 inhibitors, more routinely after metformin, rather than sulfonylureas or basal insulin.
While the study’s findings are concerning, it’s important to note that the research was observational and used data from 132,737 patients with Type 2 diabetes who were starting second-line treatment.
The scientists used real-world evidence that complements findings from previous randomized trials which studied only one active drug compared to a placebo.
Additionally, the study did not examine whether sulfonylureas and basal insulin are still beneficial for some patients or how the drugs compare to newer classes of medications in terms of their ability to control blood sugar levels.
Nonetheless, the study has raised concerns about the safety of sulfonylureas and basal insulin, which are prescribed to more than half of patients nationwide who need a second-line drug.
The numbers are staggering when applied to the 30 million Americans with diabetes, with doctors only having to prescribe basal insulin to 37 people over two years to observe one cardiovascular event, such as a heart attack, stroke, heart failure, or amputation.
For sulfonylureas, that number was a bit higher—103 people.
The findings suggest that people with type 2 diabetes should know if the medications they’re taking to treat their diabetes could lead to serious cardiovascular harm.
This calls for a paradigm shift in the treatment of type 2 diabetes, where physicians should consider newer classes of antidiabetic medications, such as GLP-1 agonists, SGLT-2 inhibitors, or DPP-4 inhibitors, more routinely after metformin.
While these drugs may be more expensive than sulfonylureas, the cost savings from avoiding hospitalizations and other cardiovascular events could potentially outweigh the costs of the medications.
It’s important to remember that preventing cardiovascular harm is not only a matter of quality of life but also saves lives.
In conclusion, the study by Northwestern University has found that the commonly prescribed second-line drugs for type 2 diabetes, sulfonylureas and basal insulin, carry a high risk of cardiovascular harm.
The study calls for a paradigm shift in the treatment of type 2 diabetes, where physicians should consider newer classes of antidiabetic medications, such as GLP-1 agonists, SGLT-2 inhibitors, or DPP-4 inhibitors, more routinely after metformin. While these drugs may be more expensive than sulfonylureas
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The research was published in JAMA Network Open and conducted by Matthew O’Brien et al.
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